Blistering distal dactylitis

Published on 18/03/2015 by admin

Filed under Dermatology

Last modified 22/04/2025

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[level-membership-for-dermatology-category]29

Blistering distal dactylitis

Irshad Zaki

Evidence Levels:  A Double-blind study  B Clinical trial ≥ 20 subjects  C Clinical trial < 20 subjects  D Series ≥ 5 subjects  E Anecdotal case reports

image

Blistering distal dactylitis (BDD) is a superficial, tender, blistering infection seen in childhood and the early teens. It is usually caused by group A β-hemolytic streptococci, although group B organisms, staphylococci and more recently MRSA have also been implicated. The distal volar fat pads of the fingers are the most common site of infection, but involvement of the nailfolds and toes can occasionally occur.

Management strategy

Blistering distal dactylitis can cause considerable alarm to parents as large tense blisters rapidly develop. Despite the absence of constitutional symptoms, patients usually seek help soon after the onset of the infection. The condition does not resolve spontaneously, but prompt treatment results in rapid improvement. Blisters should be incised to release fluid, which can vary from clear and watery to frank pus. Subsequent application of topical antibiotics can be helpful, but systemic treatment is usually also required. Penicillin V is the treatment of choice for streptococcal infection, but erythromycin is an effective alternative for patients allergic to penicillin.

The differential diagnosis of the condition includes traumatic blisters, herpetic whitlow, staphylococcal bullous impetigo, and the Weber–Cockayne variant of epidermolysis bullosa.

Specific investigations

Second-line therapies

image Systemic erythromycin D
image Intravenous vancomycin D

[/level-membership-for-dermatology-category][not-level-membership-for-dermatology-category]29

Blistering distal dactylitis

Irshad Zaki

Evidence Levels:  A Double-blind study  B Clinical trial ≥ 20 subjects  C Clinical trial < 20 subjects  D Series ≥ 5 subjects  E Anecdotal case reports

image

Blistering distal dactylitis (BDD) is a superficial, tender, blistering infection seen in childhood and the early teens. It is usually caused by group A β-hemolytic streptococci, although group B organisms, staphylococci and more recently MRSA have also been implicated. The distal volar fat pads of the fingers are the most common site of infection, but involvement of the nailfolds and toes can occasionally occur.

Management strategy

Blistering distal dactylitis can cause considerable alarm to parents as large tense blisters rapidly develop. Despite the absence of constitutional symptoms, patients usually seek help soon after the onset of the infection. The condition does not resolve spontaneously, but prompt treatment results in rapid improvement. Blisters should be incised to release fluid, which can vary from clear and watery to frank pus. Subsequent application of topical antibiotics can be helpful, but systemic treatment is usually also required. Penicillin V is the treatment of choice for streptococcal infection, but erythromycin is an effective alternative for patients allergic to penicillin.

The differential diagnosis of the condition includes traumatic blisters, herpetic whitlow, staphylococcal bullous impetigo, and the Weber–Cockayne variant of epidermolysis bullosa.